ABSTRACT
A pesar del uso de corticoides inhalados en el tratamiento del asma bronquial existe un número variable de pacientes que no logran el control de su enfermedad. En estos casos, una de las alternativas terapéuticas propuesta por diversas guías clínicas es la adición de beta 2 agonistas de acción prolongada. Este articulo, revisa las características farmacológicas, posibles efectos adversos y las indicaciones en niños.
Subject(s)
Humans , Child , Anti-Asthmatic Agents/therapeutic use , Bronchodilator Agents/therapeutic use , Adrenergic beta-Agonists/therapeutic use , Asthma/drug therapy , Anti-Asthmatic Agents/adverse effects , Anti-Asthmatic Agents/pharmacology , Bronchodilator Agents/adverse effects , Bronchodilator Agents/pharmacology , Adrenergic beta-Agonists/adverse effects , Adrenergic beta-Agonists/pharmacology , Combined Modality Therapy , Adrenal Cortex Hormones/therapeutic useABSTRACT
Este artículo revisa los factores que influyen en el éxito de terapias con inhaladores de dosis medida en niños las que comprenden desde características farmacocinéticas de las drogas hasta la adherencia al tratamiento.
Subject(s)
Humans , Child , Adrenergic beta-Agonists/administration & dosage , Albuterol/administration & dosage , Asthma/drug therapy , Adrenal Cortex Hormones/administration & dosage , Metered Dose Inhalers , Adrenergic beta-Agonists/pharmacokinetics , Albuterol/pharmacokinetics , Adrenal Cortex Hormones/pharmacokinetics , Inhalation Spacers , Patient ComplianceABSTRACT
La bronquiolitis obliterante (BO) es un síndrome clínico poco frecuente en niños, caracterizado por la obstrucción crónica al flujo de aire asociado a cambios inflamatorios y distintos grados de fibrosis en la vía aérea pequeña. Si bien existen muchas etiologías, la causa mas frecuente se asocia a infeccionesrespiratorias virales, principalmente adenovirus. No existe un consenso para establecer su diagnóstico; sin embargo, se considera un espectro de síntomas persistentes asociados a un patrón en mosaico, bronquiectasias y atelectasias persistentes. El rol de la biopsia pulmonar ha sido cuestionado por subajo rendimiento, invasividad y complicaciones. No existe un tratamiento específico por lo que elmanejo es soporte. Probablemente la mejor estrategia constituya el empleo de antibióticos en forma agresiva, soporte kinésico y nutricional constante y una precoz rehabilitación pulmonar. Estas guías clínicas representan un esfuerzo multidisciplinario, basado en evidencias actuales para brindarherramientas prácticas para el diagnóstico y cuidado de niños y adolescentes con BO post infecciosa.
Subject(s)
Humans , Adolescent , Child , Bronchiolitis Obliterans/diagnosis , Bronchiolitis Obliterans/therapy , Pulmonary Medicine/standards , Bronchiolitis Obliterans/etiology , Bacterial Infections/complications , Virus Diseases/complicationsABSTRACT
To describe clinical, pulmonary function, and chest tomography profiles in a 5-year follow-up of infants with adenovirus pneumonia and determine the factors that potentially contributed to the development of bronchiolitis obliterans (BO). We prospectively assessed 45 hospitalized infants with adenovirus pneumonia with additional follow-up for 5 years. At the end of the study, pulmonary function by impulse oscillometry technique (IOS) and chest tomography were performed in the 38 surviving patients (mean 5.7 years of age). We divided the population between those who developed chest tomography evidence of BO and those who did not. Most of the children developed adenovirus infection before 2 years of age. During the 5 years of follow-up, almost half (47.4%) developed BO. Children who developed BO had significantly more respiratory compromise (intensive care admission, need for mechanical ventilation and for oxygen therapy, and systemic corticosteroid and beta agonist use) during their adenovirus pneumonia episode than those who did not develop BO. Only 33.3% of children with BO had normal impedance compared with 85% in the no BO group. Children who developed BO had significantly higher levels of Zrs, R5, X5 and predicted Zrs, R5, and X5 and frequency. However, there were no differences in the beta 2 agonist response between the children with and without BO (94% vs. 80%, respectively). This study represents the spectra of adenovirus pneumonia ranging from relatively mild to severe and fatal cases. Children with severe pulmonary compromise are usually more prone to develop BO.
Subject(s)
Adenovirus Infections, Human/complications , Bronchiolitis Obliterans/etiology , Pneumonia, Viral/complications , Adenovirus Infections, Human/epidemiology , Bronchiolitis Obliterans/epidemiology , Bronchiolitis Obliterans/physiopathology , Child , Child, Preschool , Chile/epidemiology , Cross Infection , Disease Outbreaks , Female , Follow-Up Studies , Hospitalization , Humans , Infant , Male , Pneumonia, Viral/epidemiology , Respiratory Function TestsABSTRACT
During 1995, we examined 2,666 Graham's tests (five perianal swabs with adhesive cellulose tape) prescribed to ambulatory patients attended in 14 public outpatient clinics and four hospitals from the north section of Santiago. The infection rates found by age groups were the following: 6,1 percent in infants (< 2 years old), 20,9 percent in pre-schoolchildren (2 < 6 years old), 35,2 percent in elementary schoolchildren (6 < 15 years old) and 15,2 percent in adults (> 15 years old). Similar percentages of E. vermicularis infections were observed in females and males patients. Frequency of infection in each month of the year varied between 17,4 and 26,8 percent, with no seasonal variation. This study and previous surveys are stressing that E. vermicularis is the most frequent helminthic agent found in Chile, specially in elementary school children.
Subject(s)
Humans , Male , Female , Infant , Child, Preschool , Adolescent , Primary Health Care/statistics & numerical data , Enterobiasis/epidemiology , Enterobius/pathogenicity , Ambulatory Care Facilities , Enterobiasis/diagnosis , Enterobiasis/drug therapy , Parasite Egg CountABSTRACT
A two year-old male who presented lack of appetite, mild coughing and one episode of vomiting was assisted in a pediatrics outpatient clinic. The parasitological examination of three stool samples of the patient revealed the presence of cryptosporidium parvum oocyts. Fecal parasitological examination of his mother and a one year-old sister showed oocyts of the same protozoon in this last patient, who was asymptomatic. With no pharmacological treatment, parasitological stool examination, performed one month later on the two children, results negative, being the boy without symptoms
Subject(s)
Humans , Male , Female , Infant , Child, Preschool , Cryptosporidiosis/diagnosis , Cryptosporidium parvum/pathogenicity , Cryptosporidium parvum/isolation & purification , Feces/parasitology , Parasite Egg Count/methods , Spiramycin/administration & dosageABSTRACT
In the period 1983-1994 a series of seroepidemiological surveys by using immunodiagnostic tests for trichinosis, was carried out in 138 localities and health institutions and health institutions from the 13 regions of the country. Thus, a total of 12,882 randomly selected persons, with different sex and age distribution, were submitted to precipitin test and indirect hemagglutination test for trichinosis. One hundred and ninety one (1.5 percent) persons resulted positive for trichinosis. Higher rates of infection were observed in central and southern Chile. No differences of positivity, according to age sex, but constant increase parallel to age of the individual were detected. The general prevalence rate of infection of 1.5 percent is in reasonable accordance with the prevalence of 2.0 percent found in human corpses in 1992
